Zoster Vaccine Recombinant
Class: Vaccines
VA Class: IM100
Brands: Shingrix
Introduction
Inactivated (recombinant) vaccine. Zoster vaccine recombinant contains recombinant varicella zoster virus (VZV) surface glycoprotein E (gE) and an adjuvant (i.e., AS01B) and is used to boost active immunity to VZV.
Uses for Zoster Vaccine Recombinant
Prevention of Herpes Zoster
Prevention of herpes zoster (zoster, shingles) in adults ≥50 years of age.
Zoster is caused by reactivation of latent VZV infection in individuals who previously had varicella (chickenpox) infection. An estimated 500,000 to 1 million cases of zoster occur each year in the US; many patients develop postherpetic neuralgia (PHN) and require long-term management for refractory PHN. Risk of developing zoster increases with age and declining cell-mediated immunity to VZV. Zoster occurs principally in individuals >45 years of age; estimated lifetime risk of zoster is ≥32%, and 50% of individuals living until 85 years of age will develop zoster.
Zoster vaccine recombinant is used to boost active immunity to VZV, thereby reducing risk of VZV reactivation. May also reduce frequency and/or duration of PHN in those who develop zoster despite vaccination.
Not indicated for treatment of zoster or PHN. Do not administer during an acute episode of zoster. Has no role in postexposure management of zoster.
Not indicated for prevention of primary varicella infection (chickenpox); do not use in children or adults <50 years of age. Has no role in postexposure management of chickenpox.
There are 2 different types of zoster vaccine commercially available in the US for immunization against zoster in adults ≥50 years of age: zoster vaccine recombinant (RZV; Shingrix) and zoster vaccine live (ZVL; Zostavax).
For prevention of zoster in immunocompetent adults ≥50 years of age, the US Public Health Service Advisory Committee on Immunization Practices (ACIP) states that zoster vaccine recombinant (not zoster vaccine live) is preferred and can be used in such individuals regardless of history of zoster or prior vaccination with varicella virus vaccine live or zoster vaccine live. The recombinant zoster vaccine also preferred in adults ≥50 years of age with certain chronic medical conditions (e.g., chronic renal failure, diabetes mellitus, rheumatoid arthritis, chronic pulmonary disease).
For prevention of zoster in immunocompetent adults ≥60 years of age, ACIP states that either zoster vaccine recombinant or zoster vaccine live can be used.
Zoster Vaccine Recombinant Dosage and Administration
Administration
Administer only by IM injection. Do not administer sub-Q, IV, or intradermally.
May be given concurrently with other age-appropriate vaccines. When multiple vaccines are administered during a single health-care visit, give each parenteral vaccine using separate syringes and different injection sites. Injection sites should be separated by ≥1 inch (if anatomically feasible) to allow approp...
